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Hope for the Alcoholic
attitudes, community programs, government action and scientific
research promise a more effective attack on alcoholism,
a major public health problem.
by Kathryn Close
SCENE IS A MUNICIPAL COURTROOM. The setting could be any
of thousands of localities throughout the United States.
The judge looks wearily down from his bench at a long line
of bleary-eyed, disheveled, haggard men. Several of them
are as familiar to him as old friends. Time after time their
faces have appeared in the morning line-up - downcast, hopeless,
a man among them puts up a defense. Each pleads guilty to
a charge of "drunk and disorderly." With the exception
of one or two "new faces" let off with an admonition,
each is led back to jail to serve a sentence of ten, thirty,
or perhaps ninety days. But they will be back in court soon.
The judge knows it; the prisoners know it. For when they
are free they will drink again, become drunk and disorderly,
be hauled into jail in a stupor, or wildly belligerent,
or just plain sick, and they will be thrown into a cell
until they are sober enough to appear in court for a new
sentence. And the circle will go round and round until they
For these men are victims of alcoholism, one of the most
vicious diseases known to mankind. And neither they nor
anyone with whom they come in contact have any hope for
them. Coming from almost any walk of life, they have "hit
bottom" as a result of a progressive disease from which
some 4,000,000 Americans are currently suffering.
Alcoholism is one of those major diseases that have been
nourished by ignorance, misunderstanding and stigma - long
the protectors of venereal disease, cancer, and tuberculosis.
If it is to be effectively attacked in the communities where
alcoholics undergo their rounds of binges, terror, and agonized
awakening, the stigma and misunderstanding surrounding it
must be lifted. Only then will the "hidden alcoholics"
- family skeletons in the closet - come forward and ask
for help or be brought forward by their relatives, and only
then will community leaders take an active interest in seeing
that the proper facilities are available to them.
some dramatic developments within the past fifteen years
indicate that the negative attitudes which have long blacked
out hope for the alcoholic may gradually be eliminated.
Happily, too, these developments augur well for a shift
in interest from an emotional controversy over liquor control
to a concern for the alcoholic as a suffering human being.
Down through the centuries people have taken sides for or
against drinking with a frenzy equaled only by their reactions
to politics or religion. But the alcoholic was lost in the
turmoil. Those against drinking saw the tragedies of alcoholism
and wanted to abolish alcohol. It was a though persons with
a knowledge of the discomforts of diabetes were to start
a movement to abolish sugar. Those who believed in the freedom
to drink fought hard for their freedom and looked down on
the man without "self-control." And in "wet"
periods or "dry" periods the alcoholic drank and
following repeal of the Prohibition Amendment, the air began
to clear. A recognition dawned that alcoholism or addictive
drinking, is not synonymous with drinking or even drunkenness;
that only a fraction of those who drink become alcoholics;
but that this fraction is large enough to represent one
of the major public health problems in the United States;
and that something must be done about it. For the first
time attention began to be diverted from alcohol to the
alcoholic. Today voluntary groups, states and municipalities
throughout the country are working out programs to help
the alcoholic get out of his vicious circle of drunkenness,
aching sobriety, and drunkenness, into satisfactory, useful
THE MAJORITY of our 4,000,000 alcoholics still swim in a
sea of hopelessness, more and more ropes are being thrown
them by groups with a conscientious awareness of their responsibility
to help. Among these are self-help groups of former alcoholics;
community committees which are setting up information centers,
clinics and hospital facilities for alcoholics; research
scientists doubling their efforts to learn more about this
disease; and enlightened government agencies which are beginning
to recognize its public health aspects.
question of whether or not alcoholism is a disease is till
in dispute among some of the groups doing most to combat
it, but the dispute boils down to one of semantics, for
all are agreed on a single concept: that alcoholism - chronic
excessive drinking, characterized by distinctive behavior
patterns - is not caused by alcohol alone, but by more or
less mysterious psychological disturbances incompatible
with the presence of alcohol. The end result is an intolerance
toward alcohol as permanent and incurable as the diabetic's
intolerance toward sugar. Just as the diabetic must abjure
sweets, the alcohol must abstain from alcohol. One drink
will lead him to a disaster.
basic cause is unknown. There may be one or many, and scientists
are searching vigorously for clues. Their researches have
brought forth the fact that there are many types of alcoholics,
variously amenable to treatment. The most reliable statistics
indicate that of 65,000,000 drinkers in the United States,
4,000,000 are chronic excessive drinkers - borderline or
actual alcoholics. These have been broken down into problem
drinkers, compulsive drinkers of primary and secondary types,
social misfits and psychotic drinkers. Of these 4,000,000
inebriates, 750,000 are chronic alcoholics or persons whose
drinking has resulted in diagnosable physical or psychol-
MOVEMENT TO EXTEND PRACTICAL help to alcoholics sprouts
from several seeds, all planted at about the same time.
The two with the most dramatic growth were sown independently
in different places in the same year. That year, a red letter
one for alcoholics, was 1935.
seed was planted in Akron, Ohio by two habitual drunks.
One was a doctor, the other a broker, both of some distinction
before alcohol addiction began to ruin their careers and
threaten to break up their homes. Intelligent men, they
fought hard, but without much success, until they managed
to get together in a sober interval. Then they decided that
one drunk might help another. Out of this idea grew the
now famous Alcoholics Anonymous. In a year's time these
two former inebriates had not only achieved continuous sobriety
for themselves, but had helped others to the same goal.
Today the organization they started has some 85,000 members
in 2,400 chapters throughout the country.
entire membership is composed of alcoholics fighting desperately
to help each other stay away from the substance that is
poison to them. Many of the members have not touched a drop
since they became A.A.' s Others have slipped from time
to time, but have returned to the organization to keep up
the fight. Some former members have sunk back into the mire
of perpetual drunkenness. But Alcoholics Anonymous, which
maintains that 75 percent of its members have achieved sobriety,
is generally conceded to present the most widely successful
attempt at alcoholic rehabilitation in this country's history.
Statistics on "success" are unreliable, for a
man who is sober today may be drunk tomorrow - even though
his sobriety has lasted over a number of years. Nevertheless,
doctors, scientists, social workers, clergymen, public health
experts, suffering relatives, and others who have had to
deal with alcoholics, have watched the A.A.'s achievements
The other seed was planted in New Haven, Connecticut, by
two scientists, Dr. Howard Haggard and Dr. Leon A. Greenberg.
Director and associate respectively, of the Yale University
Laboratory of Applied Physiology, they were carrying on
research in the effects of alcohol on the human body. This
led them into an awareness of alcoholism as a phenomenon
distinct from normal drinking or occasional drunkenness.
As they continued their studies they realized that alcoholism
could not be studied in a test tube, that too many factors
involving disciplines other than physiology were concerned.
Accordingly they raised the money to enlarge their staff
to include sociologists, psychiatrists, psychologists, economists,
and medical men. Today the laboratory's section on alcohol
is larger than all the rest of its sections combined and
heads up the program of research, education, and treatment
that has come to be known the country over as the Yale Plan
From these two seeds have emerged the present sturdy sprouts
of public and community concern. The A.A. experience has
created a growing awareness of the fact that alcoholics
are not "weak-willed" or "immoral,"
but people who need and can respond to the proper kind of
help. In a twelve-point program chiefly emphasizing insight,
fellowship, work for others, and spiritual faith, A.A. has
wrought miracles that no amount of pleading, threats, shame,
cajolery or punishment has ever been able to effect. Simultaneously,
the Yale Plan has brought to light scientific facts about
a problem formerly regarded only with emotion, indifference,
or disgust. Largely because the scientists at Yale have
insisted upon putting their knowledge to use, communities
and government agencies throughout the country are beginning
to stir from their lethargic indifference to do something
realistic about their alcoholics.
thirteen states have initiated programs concerned with alcoholism,
while in fifty cities throughout the country voluntary committees
are surveying the local problem and taking action to meet
it. In addition, a number of municipalities, notably, New
York, Washington, D.C., and Oakland, California, are beginning
to recognize the fact that the jails are no answer to a
public health problem and are experimenting with more effective
types of treatment programs.
ITS FOURTEEN YEARS OF existence the Yale Plan has gradually
enlarged its original test tube focus to embrace six main
divisions: Research; Publications; the Yale Summer School
on Alcoholic Studies; the Yale Plan Clinic; the National
Committee for Education on Alcoholism; and the recently
inaugurated Yale Institute of Alcoholic Studies in the Southwest.
Each has a reach far beyond the academic setting where the
Research Division conducts studies on the effects of alcohol
on humans - moderate drinkers as well as inebriates. Currently
it is attempting to find the physiological disturbances
that scientists feel must accompany the psychological factors
in alcoholism - a theory based on the observation that though
the alcoholic can be converted to a total abstainer, he
can never hope to be a moderate drinker no matter how well
adjusted he becomes through psychiatric treatment or other
means. Such knowledge, if attained, might not only bring
about a revolution in treatment methods, but also a hope
of prevention by making it possible to spot a potential
alcoholic before he has ever taken a drink.
Publications Division brings together the findings of scientific
research on alcoholism and of medical psychiatric, social,
and legal experience with alcoholics. Chief among its publication
is The Quarterly Journal of Studies in Alcohol, the bible
of the field.
the realization that knowledge in an ivory tower can be
of little help to the sinking alcoholic, his harried wife,
or terrified children, the instigators of the Yale Plan
determined to spread what they learned as quickly as possible
to persons who could put the facts to most effective use.
Accordingly in 1943 they inaugurated the Yale Summer School
of Alcohol Studies, a four week course for persons professionally
concerned with alcoholics or education on alcoholism - doctors,
ministers, social workers, police chiefs, judges, teachers.
The curriculum, which covers almost everything, that is
known about alcohol and alcoholism, focuses on alcoholism
as a disease and the alcoholic as a sick person who should
be treated with kindness, sympathy, and firmness and without
resentment or moral judgment. The role of education in prevention
is equally stressed, with the emphasis on supplanting "folklore"
with true facts - for example the common belief that alcohol
is a stimulant with the fact that alcohol is a depressant,
or the not unpopular assumption that drinking inevitably
leads to alcoholism, with a clear definition between the
moderate drinker and the addict.
200 persons have registered at the summer school each year
since its opening. In addition, so many others have indicated
interest in the course that this year a similar summer school
will be held at Trinity University, San Antonio, Texas,
under the auspices of a newly organized Yale Institute of
Alcoholic Studies in the Southwest jointly sponsored by
Yale and Texas Christian University. The new project includes
plans for research, a summer school and clinical facilities
similar to the parent program at New Haven. It is under
the direction of Dr. E.M. Jellinek, biometrician with the
Yale Plan since the first expansion from its physiological
FINDINGS ARE OF little use to the sick unless translated
into treatment. The Yale Plan Clinic, with a staff of two
psychiatrists, a physician, a psychologist, and two psychiatric
caseworkers, opened in 1944 as a demonstration of an integrated
approach to the rehabilitation of alcoholics. Far from an
attempt to compete with New Haven's flourishing A.A. chapter,
the clinic is an effective complement to the group.
In spite of the relative success of Alcoholics Anonymous
a group fellowship program does not answer the needs of
all alcoholics - nor even of all who want to be cured. In
many persons alcoholism is merely a symptom of some deep
disturbance of either a psychological or physical nature.
Thus a brain tumor may have its first manifestations in
excessive drinking; a psychotic of the manic depressive
type may go on bouts in his depressed periods; a person
with deep neurotic conflicts may find in alcohol his only
release; or an "uncomplicated alcoholic" may cringe
from the testimonial or religious facets of the A.A. program.
All these persons need diagnosis and individualized treatment.
Only an operation will help the man with the brain tumor.
The psychotic will need care in a mental hospital; the neurotic,
deep psychotherapy; while the uncomplicated alcoholic may
need less intensive psychiatric help in gaining insight
into the nature of his affliction, along with some counseling
and guidance in regard to employment, domestic troubles,
or social interests.
Diagnosis was from the first a major concern of the Yale
Plan Clinic, but experience soon demonstrated that if diagnosis
was to have any meaning it would have to followed by therapy
and guidance in cases needing treatment not provided by
other community services. Since its opening the clinic has
received 1,100 alcoholics, 60 per cent of whom have achieved
either complete sobriety or markedly lengthened spacing
between their drinking bouts. Referrals between the clinic
and Alcoholics Anonymous are a commonplace, the clinic getting
patients from A.A. and in turn recommending A.A. to persons
who seem able to benefit from the fellowship program. Many
persons are clinic patients and active A.A. members at the
Yale Plan Clinic was developed as a model for other communities
as well as for experimental purposes. But neither Yale nor
Alcoholics Anonymous pretended to be able to tackle the
whole cast problem of alcoholism alone. No real dent is
ever made in a public health problem until widespread understanding
of its true nature develops.
For four years the National Committee for education on Alcoholism,
an affiliate of the Yale Plan, has been trying to break
down community ignorance and indifference, through field
trips, consultation services, the provision of literature,
and the promotion of institutes. The fifty communities which
have setup local committees for education on alcoholism
provide a measure of its success.
committees are usually composed of persons of some influence
in the community because of their social or professional
standing, as well as of persons whose work brings them in
close contact with alcoholics or their families - social
workers, doctors, clergymen, judges, teachers, and members
of Alcoholics Anonymous. As a rule, they begin shooting
at three main goals: general public education on the problem
and nature of alcoholism; the establishment of an information
center where alcoholics, their relatives, and other interested
persons can find out more about the disease and where to
go for effective treatment; promotion or establishment of
specialized clinics, hospital beds, and convalescent homes
local committees are in various stages of development. Though
the oldest was created in Boston early in 1945, many of
them only came into being in recent months, and are still
in the organizational stage. Nineteen, however, are far
enough along to be operating information centers as well
as community education programs; and a few are offering
direct rehabilitation services.
One of the more highly developed is the Western Pennsylvania
Committee for education on Alcoholism, in Pittsburgh. Organized
in 1945, this committee carries on a continuous educational
program through a speaker's bureau, institutes, and the
dissemination of literature, emphasizing the three points
stressed by the national committee; alcoholism is a disease;
the alcoholic can be helped; alcoholism is a public health
problem. In addition, the committee operated an information
center and diagnostic clinic, staffed by a psychiatrically
oriented physician and the executive secretary, who is a
trained social worker. The center cooperates closely not
only with the A.A.'s, but with other community agencies
serving alcoholics, particularly Morals Court. The committee
has fortunately been spared a problem which looms heavily
in other areas, the securing of hospital facilities for
alcoholics, for Pittsburgh is one of the few communities
where hospital beds are available to alcoholic patients.
to get a person suffering from acute alcoholism into hospitals
is an urgent problem in most communities. Acute alcoholism
is often an extremely dangerous state which can be fatal
if emergency medical treatment is not provided. The number
of alcoholics found dead in their cells after being callously
tossed into jail to "sleep it off" probably never
will be tabulated, but anyone who has been around jails
knows that this occurrence is not uncommon. Good hospital
care in the sobering up period may also be crucial to rehabilitative
efforts, since the mental and physical pain of the hangover
is what frequently drives the alcoholic back to drink.
Few communities, however, have sufficient, if any, hospital
beds available for alcoholics, a situation mainly due to
the general hospital's disinterest in the alcoholic as a
patient. While some municipally owned hospitals operate
alcoholic wards, general hospitals more often than not refuse
to have anything to do with the alcoholic patient except
in extreme emergencies.
the lack of hospital facilities has long handicapped their
work, many A.A. groups have exerted special efforts to persuade
general hospitals to provide beds for such patients, but
without much success. A notable exception is in New York
City where the Knickerbocker Hospital has given over an
entire wing to alcoholics and put admission into the hands
of the A.A.'s. Every person admitted to Knickerbocker's
wing for alcoholics is assigned an A.A. sponsor, who visits
the patient every day during his five-day stay and is the
only visitor allowed. Doctors, nurses, and the A.A. visitors
urge the patient to a realization that hospital treatment
is only the beginning of rehabilitation and must be followed
through by the patient's own efforts if real recovery is
to be achieved.
frustrated in their attempts to secure hospital beds, A.A.
chapters are welcoming such efforts on the part of local
committees for education on alcoholism, in the hopes that
these representative community groups may be able to achieve
through prestige what the A.A. 's with no pressure group
value, have found extremely difficult. A number of local
committees already have experienced some success in this
direction. Only one, however, the Youngstown (Ohio) Committee
for Education on Alcoholism, has managed to secure an entire
hospital for alcoholics, which it owns and operates itself.
As in the case of the A.A. association with New York's Knickerbocker
Hospital, this system makes it possible to screen patients
carefully at the point of admission so that the beds are
made available to those most in need of them. It also makes
it possible to offer rehabilitative service at the time
of convalescence when the patient is more apt to be in a
IS CALLED THE FOURTH public health problem in the United
States. As such it warrants attention from the public authorities
as well as from voluntary groups. Recent actions of thirteen
state legislatures in authorizing programs on alcoholism
indicate that such attention may at last be forthcoming.
of the state programs are headed by legislatively created
commissions with varying degrees of responsibility. Some
commissions are charged only with providing educational
programs. Others, responsible also for surveying the problem
and establishing facilities to meet needs, are hamstrung
by inadequate appropriations. However, a few have drawn
up comprehensive plans for education, rehabilitation, and
the most ambitious state programs is that of the Connecticut
Commission on Alcoholism, set up by the state legislature
in 1945. With an income of about $200,000 a year, representing
9 percent of the state's revenues from liquor licenses,
the commission plans to operate a network of out-patient
clinics modeled on the Yale Plan Clinic, as well as hospitals
and possibly convalescent hones for alcoholics. Already
three of the clinics are in operation, and plans for opening
a fifty-bed hospital in Hartford are nearly completed. The
commission benefits considerably from consultation with
the Yale Plan staff and has its chairman, Selden D, Bacon,
staff sociologist at the Yale Laboratory of Applied Physiology.
A joint undertaking with the Yale Plan Clinic involves special
services and research among women alcoholics at the State
Reformatory for Women.
Oregon is unique in having developed a rehabilitation program
under the auspices of an advisory committee to the State
Liquor Control Commission. Here, too, the funds come from
liquor licenses, and bring $115,000 biennially to the state's
outpatient alcoholic clinic located in Portland. Plans for
expanding the clinic's services to other areas in the state
are currently under consideration.
Washington, D.C., has two clinics operating under the Bureau
of Mental Hygiene of the District's Health Department, and
a third in the offing. The latter, authorized by a special
act of congress in 1947, and to be financed by liquor license
revenues, will cooperate closely with the District Courts.
Under the proposed plan the courts will send men and women
to the clinic on probation.
Most clinics for alcoholics have a voluntary arrangement
with the courts in their communities. Apparently the judges,
weary of sentencing endless lines of familiar drunks to
ineffectual jail terms, welcome the opportunity to break
the vicious cycle. Usually, however, they refer only those
alcoholics who would seem amenable to treatment - newcomers
to their courts or persons in whom the repeating pattern
has not been long established. The 69-year-old woman who
had 124 jail sentences in New Jersey would probably not
be considered a good treatment prospect.
In Oakland, California, a court-devised plan for breaking
the circle of spree-jail-spree leans heavily on the authority
of the court. Its instigators were two probation officers
- one a "graduate" of the Yale Summer School of
Alcoholic Studies - who persuaded the county judge to let
them take a try at rehabilitating police court alcoholics.
Accordingly, the judge, who used to sentence the day's line-up
of 60 to 100 drunks en masse, views each inebriate as an
individual person and fits the "punishment" not
to the crime, but to the man's or woman's potentialities
for rehabilitation. Those he regards as capable of straightening
out without benefit of institutional care he puts on probation,
leaving to the probation officer the job of painstaking
guidance or referral to other services. Others who obviously
need the protection of an institutional setting he sends
to the county farm.
question of the compulsory treatment of alcoholics is still
under debate, but opinion seems to be growing that the protection
of society as well as of the victims of also holism demands
a move in this direction. In New York State a bill drawn
up by the State Bar Association, and already introduced
in the legislature, would authorize a proposed Bureau for
Alcoholics to establish state farms for alcoholics to which
persons needing long term institutional treatment could
be committed by the courts, either after arrest or at their
own relatives request. The bill would not only provide needed
treatment facilities, far superior to jails, but would make
commitment long enough for rehabilitation to get a good
OF THE MOST VIGOROUS opponents of compulsory treatment is
a man who through his own experience has devised a unique
method of rehabilitation which he tried out on others with
considerable success. Edward J. McGoldrick, Jr., director
of New York City's Bureau of Alcoholic Therapy, established
within the Department of Welfare in 1943, is an individualist
among alcoholic therapists for he also holds out against
the theory that alcoholism is a disease. The method which
he uses at Bridge House, the bureau's convalescent home
for selected male alcoholics, is based on theories of will
and thought control. Agreeing with the scientists that alcoholism
has a "psychic" basis, Mr. McGoldrick has developed
a system of personal interviews and group lectures intended
to convert the alcoholic from a sense of defeat to a sense
of power over himself.
therapists at Bridge House are former alcoholics who have
been rehabilitated through the McGoldrick method. Though
the method differs from procedures of Alcoholics Anonymous,
the director goes along with them in the theory that persons
who have "hit bottom" as alcoholics themselves
can more easily help other alcoholics.
Mr. McGoldrick objects to calling alcoholism a disease on
the grounds that it adds to the alcoholic's sense of weakness
and helplessness, thus giving him an excuse to go on drinking.
He opposes compulsory treatment as useless, for it ignores
the ingredient of positive willingness which he feels is
necessary to reform.
House, with only twenty beds, serves about 350 alcoholics
a year, both on a resident and a non-resident basis. Its
record of success, using Mr. McGoldrick's measurement of
one year of complete sobriety, is 66 percent - a good record
but one not affecting some 200,000 alcoholics in New York
City who do not reach Bridge House, nor any of the city's
alcoholic women. It is, however, a project being watched
throughout the country.
as well as the public has a real stake in combating alcoholism,
for alcoholic workers cause a tremendous waste. It has been
estimated that the 1,370,000 alcoholic males employed in
heavy industry lose an average of 22 days each year from
the acute effects of alcohol. Moreover, the alcoholic has
an accident rate twice as high as the non-alcoholic. On
the basis of such statistics, the Yale Plan Clinic is offering
industrial plants a service to help take up the fight against
this menace. This involves a survey of the extent of the
plant's problem, help in developing constructive personnel
policies affecting the alcoholic, the introduction of an
educational program and an information service for workers,
and help in establishing rehabilitation facilities.
All the efforts so far initiated to help the alcoholic seem
infinitesimal when viewed against the size of the problem.
But it is encouraging to remember that fifteen years ago
practically nothing at all effective was being done in this
direction. The developments which have come in that short
time mark an auspicious awakening to a long neglected responsibility.
SURVEY, April 1949)